Study of efficacy and safety of through-the-scope twin clip for endoscopic submucosal dissection defect closure in the proximal colon

doi:10.3877/cma.j.issn.2095-2015.2025.03.004

Abstract

Abstract:

Objective

To evaluate the efficacy and safety of through-the-scope twin clip(TTS-TC) for endoscopic submucosal dissection (ESD) defect closure in the proximal colon.

Methods

A total of 113 patients underwent proximal colon ESD and had lesions >2 cm at Beijing Friendship Hospital Affiliated to Capital Medical University from March 1, 2022 to February 28, 2025 were retrospectively selected.The patients were divided into 26 cases in the TTS-TC group and 87 cases in the traditional metal clip group.The wound closure time, difficulty and effectiveness were statistically analyzed respectively,and the postoperative diet resumption time, duration of antibiotic use, and length of hospital stay of the two groups of patients were statistically analyzed.

Results

In terms of the time spent on wound closure, the TTS-TC group showed a shorter duration than the traditional metal clip group [(12.11±3.69) min vs.(13.85±3.96) min, P=0.04].Meanwhile, patients undergoing TTS-TC-assisted required fewer clips to achieve complete closure (P<0.01).In terms of postoperative recovery, the TTS-TC group showed earlier resumption of oral intake compared to the conventional clip group (P=0.03).Both novice endoscopists(coefficient 0.83, P<0.01) and experienced endoscopists (coefficient 0.79, P<0.01) agreed that TTS-TC facilitated closure.Novice endoscopists reported that TTS-TC was particularly beneficial for them(χ²=8.15, P=0.04).

Conclusion

TTS-TC has certain advantages over traditional metal clips.It can effectively reduce the defect closure time and the number of clips required, and shorten the time for patients to resume eating.TTS-TC appears to be particularly beneficial for novice endoscopists to close larger and more difficult wounds.

Key words: Through-the-scope twin clip, Endoscopic submucosal dissection, Defect closure, Proximal Colon

Yu Zhao, Jiani Jiang, Fujing Lyu, Shutian Zhang. Study of efficacy and safety of through-the-scope twin clip for endoscopic submucosal dissection defect closure in the proximal colon[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(03): 210-213.

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URL: https://zhxhbyyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2015.2025.03.004

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Figures/Tables 3

项目	TTS-TC 组(n=26)	金属夹组(n=87)	P值
年龄(岁, $\overset{ˉ}{x}$ ± s )	58.08±10.46(41～77)	58.65±6.75(48～70)	0.71
性别[男,例(%)]	19(73.08)	62(71.26)	0.86
病变大小(cm, $\overset{ˉ}{x}$ ± s )	2.89±0.49	2.75±0.41	0.56
切除时间(min, $\overset{ˉ}{x}$ ± s )	73.12±15.34	73.51±10.69	0.77
闭合时间(min, $\overset{ˉ}{x}$ ± s )	12.11±3.69	13.85±3.96	0.04
闭合成功[例(%)]	26(100)	82(94.25)	0.18
术中穿孔[例(%)]	4(15.38)	8(9.20)	0.37
夹子用量(个)^#	10(8～13)	12(4～16)	＜0.01

项目	TTS-TC 组(n=26)	金属夹组(n=87)	P值
年龄(岁, $\overset{ˉ}{x}$ ± s )	58.08±10.46(41～77)	58.65±6.75(48～70)	0.71
性别[男,例(%)]	19(73.08)	62(71.26)	0.86
病变大小(cm, $\overset{ˉ}{x}$ ± s )	2.89±0.49	2.75±0.41	0.56
切除时间(min, $\overset{ˉ}{x}$ ± s )	73.12±15.34	73.51±10.69	0.77
闭合时间(min, $\overset{ˉ}{x}$ ± s )	12.11±3.69	13.85±3.96	0.04
闭合成功[例(%)]	26(100)	82(94.25)	0.18
术中穿孔[例(%)]	4(15.38)	8(9.20)	0.37
夹子用量(个)^#	10(8～13)	12(4～16)	＜0.01

项目	TTS-TC 组(n=26)	金属夹组(n=87)	P值
术后发热[例(%)]	5(19.23)	23(26.43)	0.45
术后腹痛[例(%)]	7(26.92)	25(29.73)	0.85
术后迟发穿孔[例(%)]	0(0)	2(2.29)	0.41
抗生素应用时间(d)^a	3(2～5)	3(2～7)	0.34
术后恢复进食时间(d)^a	2(2～4)	3(2～7)	0.03
术后住院时间(d)^a	3(2～6)	3(2～8)	0.54

组别	例数	创面封闭难度评分^a	TTS-TC有效性评分^a	相关系数	P值
初学者组	11	3(2～4)	3(2～4)	0.83	＜0.01
熟练者组	15	3(2～4)	2(2～4)	0.79	＜0.01
χ ²		0.32	8.14	-	-
P值		0.85	0.04	-	-

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